Healthcare Provider Details

I. General information

NPI: 1306815105
Provider Name (Legal Business Name): BRUCE HORATIO WARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 W LEIGH ST SUITE 205
RICHMOND VA
23220-3200
US

IV. Provider business mailing address

505 W LEIGH ST
RICHMOND VA
23220-3200
US

V. Phone/Fax

Practice location:
  • Phone: 804-788-0004
  • Fax: 804-788-0120
Mailing address:
  • Phone: 804-562-2769
  • Fax: 804-269-3406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101034738
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101034738
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: